Pneumonia is the leading cause of death among young children worldwide, primarily in low and middle-income countries (LMIC). Since children with pneumonia ultimately die of respiratory failure, factors such as anemia that affect delivery of oxygen to the tissues may affect patient outcomes. Anemia is very common in LMIC, affecting two-thirds of children in Sub-Saharan Africa and Southeast Asia, and it may be a target for therapy in some patients with pneumonia. The overarching goal of this research is to describe the outcomes of children hospitalized with the combination of severe pneumonia and moderate/severe anemia in order to obtain preliminary data that will inform a future prospective treatment trial. In our prior work, we found that the combination of anemia and high altitude is particularly harmful among children with severe pneumonia. This study did not include many children with severe anemia; by extension, I hypothesize that severe anemia will be associated with poor outcomes in pneumonia, even at low altitude. I will test this hypothesis through an observational study of children admitted with severe pneumonia and moderate/severe anemia to Mbarara Regional Referral Hospital, our collaborating institution in Southwest Uganda. In Aim 1, I will measure the effect of hemoglobin on time to recovery from severe pneumonia. In Aim 2, I will evaluate the effect of low hemoglobin on tissue hypoxia, as measured by blood lactate. Correcting severe anemia will in some cases require red blood cell (RBC) transfusion, and Aim 3 will evaluate the safety of RBC transfusions among patients with severe pneumonia by measuring the risk of transfusion-associated circulatory overload (TACO) in patients receiving transfusions. The larger research goal is to identify modifiable risk factors that influence outcomes in children with pneumonia. I have already received clinical training in pulmonary disease and critical care. As part of the F32 training program, I will develop skills in clinical ad translational research through mentorship by Dr. Patricia Hibberd, an established expert in respiratory infections, global child health, and patient-oriented clinical research who has conducted translational through Phase IV studies on the prevention and treatment of childhood pneumonia in the US and in low-income countries. The training will be augmented by coursework in global health, research methods, infectious disease epidemiology, nutrition, and advanced biostatics. I anticipate that the findings from this research will inform global public health efforts to reduce pneumonia mortality among children.